Volume 14, 2016

 

Issue 38 – Reminder about Medical Record Submission for Quality Incentive Programs
We want to remind you that you have until January 13, 2017 to submit medical records for P4P quality compliance measures for the 2016 measurement year.
Issue 37 – NYS Opioid Legislation Mandate: Updates to Inpatient Substance Use Disorder Preauthorization
There are changes to the utilization review requirement for inpatient admission for the treatment of substance use disorder (SUD).
Issue 36 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 35 – Important Notification Regarding an Addition to Our Quality Incentive Fee Schedule
There is an addition to the 2016 Physician Performance Quality Incentive fee schedule.
Issue 34 – Changes to Drug Therapy Guideline for Enbrel
We want to let you know about changes to our 2017 drug therapy guideline for Enbrel®.
Issue 33 – Important Notification Regarding Changes to our Incentive Fee Schedule and Quality Performance Programs
We want to let you know about additional changes to our 2016 Physician Performance Quality Initiative.
Issue 32 – Drug Therapy Guideline Updates Available on our Website
We want to let you know that drug therapy guidelines have been reviewed and updated.
Issue 31 – Medicare Advantage Quality Incentive Program
We want to let you know about a new performance and quality program for primary care physicians (PCPs).
Issue 30 – 2017 DME Fee Schedule Announced
We want to let you know that we will be issuing an updated corporate DME Fee Schedule, which will take effect January 1, 2017.
Issue 29 – 2017 Chiropractic Fee Schedule Announced
We want to let you know that we will be issuing an updated Chiropractic Fee Schedule, which will take effect January 1, 2017.
Issue 28 – 2017 Fee Schedule Announced
We want to let you know that we will be issuing an updated Standard Commercial Fee Schedule, which will take effect January 1, 2017.
Issue 27 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 26 – Record Submission for Quality Incentive Programs
We want to let you know about updates to our quality incentive programs and how you can submit records to close gaps in care.
Issue 25 – Lab Services Update
A preauthorization is required for specimens that are collected in your office and referred to a non-participating laboratory for testing. Quest Diagnostics is the preferred in-network laboratory for all BlueShield of Northeastern New York coverage plans.
Issue 24 – Drug Therapy Guideline Updates Now Available on Our Website
We want to let you know about our updated drug therapy guidelines.
Issue 23 – Patient-Centered Medical Home Reminder
We want to remind you about our notification process regarding changes in National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) recognition status.
Issue 22 – Change in Laboratory Participation Status
We want to let you know that certain clinical laboratories will no longer be participating with BlueShield of Northeastern New York.
Issue 21 – 2015 Pay for Performance Summary
We want to let you know that the 2015 Pay for Performance (P4P) incentive payments have been mailed and summary reports are now available on our secure provider website.
Issue 20 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 19 – Notice of New Annual Regulatory Audit
We want to let you know that, as a result of the Accountable Care Act, individual and small group products—both on- and off-exchange—are now risk-adjusted.
Issue 18 – Changes to Hepatitis C Drug Therapy Guidelines
We want to let you know about an update to our hepatitis C drug therapy guidelines.
Issue 17 – Revised Anesthesia Billing Update
We want to let you know about changes to billing for anesthesia services.
Issue 16 – Diabetic Eye Exam Reminder
We want to let you know about efforts underway to improve communication between providers caring for the same patient. The goal is to improve quality and continuity of care.
Issue 15 – Drug Therapy Guideline Updates Available on our Website
We want to let you know about drug therapy guidelines that will take effect June 15, 2016.
Issue 14– Hospital-based Providers Enrollment Update
Certain hospital-based providers, while not subject to credentialing, needed to register with us in order to participate in the BlueShield of Northeastern New York network.
Issue 13 – Performance and Quality Program Reminder
We want to remind you about our 2016 physician performance and quality initiative.
Issue 12 – Anesthesia Billing Update
We want to let you know about changes for billing anesthesia services.
Issue 11 – Revised CMS-1500 Claim Form (2/12): Final Notice
We want to remind you that, effective May 1, 2016, we are no longer accepting the CMS-1500 claim form (8/05). Incomplete, invalid, and/or incorrect claims will be returned.
Issue 10 – No Preauthorization Required for Trigger Point Injections
As a follow up to our January 15 stat bulletin about the Palladian Health Spine Pain Management Program, we want to clarify that trigger point injections do not require preauthorization.
Issue 9 – Reimbursement Changes: Medical Injectables
We want to let you know about the corporate medical injectable fee schedule changes, which take effect on July 1, 2016.
Issue 8 – 2016 Fee Schedule Announced
We want to let you know that BlueShield of Northeastern New York will issue an updated Standard Commercial Fee Schedule that will take effect July 1, 2016.
Issue 7 – Provider Data Validation
We want to let you know that, effective January 1, 2016, the Centers for Medicare & Medicaid Services (CMS) began enforcing regulations about changes in the Medicare program regarding accurate provider directory information.
Issue 6 – Drug Therapy Guideline Updates
We want to let you know about drug therapy guidelines that will take effect March 15, 2016.
Issue 5 – Fee Schedule/Performance and Quality Program Reminder
We want to remind you about the additional incentives that you can earn in 2016 through our Annual Wellness Visit (AWV) Initiative Program.
Issue 4 – Changes to our Performance and Quality Programs
We want to let you know about our 2016 physician performance and quality initiatives.
Issue 3 – Revised CMS-1500 Claim Form (2/12)
As a reminder, the revised CMS-1500 claim form (2/12) was implemented April 1, 2014. Effective May 1, 2016, the CMS-1500 claim form (8/05) will no longer be accepted. Incomplete, invalid, and/or incorrect claims will be returned.
Issue 2 – Medication Therapy Management Program
The Centers for Medicare & Medicaid Services (CMS) requires that each Medicare Part D plan provide a Medication Therapy Management (MTM) program benefit.
Issue 1 – Spinal Procedure Preauthorizations through Palladian Health
We want to let you know that, effective April 15, 2016, preauthorizations for inpatient and outpatient spinal procedures will be managed through Palladian Health®.